Compare: Benefits package

Joint Learning Network for Universal Health Coverage

The Joint Learning Network for Universal Health Coverage systematically documents the reforms of its member countries and other countries that have expanded health coverage through demand-side financing. The case studies contained in these pages are brief, comparative and modular in nature, describing the key highlights and technical features of each program.


Compare various dimensions of country reform efforts using our interactive tool.


Program Types of benefits Benefits package
Nigeria: National Health Insurance System
  • Comprehensive

The benefits package for the National Health Insurance Scheme for workers in the formal sector is pre-determined and includes:

  • Out-patient care, including necessary consumables
  • Prescribed drugs, pharmaceutical care and diagnostic tests on the National Essential Drugs List and Diagnostic Test Lists
  • Maternity care for up to 4 live births for every insured contributor
  • Preventive care, including immunization, health education, family planning, antenatal and post-natal care
  • Consultation with specialists with a referral
  • Hospital in-patient care in a standard ward for a 15 cumulative days per year
  • Eye examination and care, excluding the provision of spectacles and contact lenses
  • A range of prostheses (limited to artificial limbs produced in Nigeria)
  • Preventive dental care and pain relief (including consultation, dental health education, amalgam filling, and simple extraction)
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The benefits package for the National Health Insurance Scheme for workers in the formal sector is pre-determined and includes:

  • Out-patient care, including necessary consumables
  • Prescribed drugs, pharmaceutical care and diagnostic tests on the National Essential Drugs List and Diagnostic Test Lists
  • Maternity care for up to 4 live births for every insured contributor
  • Preventive care, including immunization, health education, family planning, antenatal and post-natal care
  • Consultation with specialists with a referral
  • Hospital in-patient care in a standard ward for a 15 cumulative days per year
  • Eye examination and care, excluding the provision of spectacles and contact lenses
  • A range of prostheses (limited to artificial limbs produced in Nigeria)
  • Preventive dental care and pain relief (including consultation, dental health education, amalgam filling, and simple extraction)

Exclusions for the package include:

  • Occupational/industrial injuries
  • High technology investigations, except in life-threatening emergencies
  • Injuries resulting from natural disasters, political conflicts, epidemics and extreme sports
  • Drug abuse/addiction
  • Transplant and cosmetic surgeries

The benefits packages for the informal program of the National Health Insurance Scheme (NHIS) are determined by the stakeholders through a process of consensus building. Members determine the benefits package according to local needs.

National Health Insurance System

Benefits package

Types of Benefits: Comprehensive

The benefits package for the National Health Insurance Scheme for workers in the formal sector is pre-determined and includes:

  • Out-patient care, including necessary consumables
  • Prescribed drugs, pharmaceutical care and diagnostic tests on the National Essential Drugs List and Diagnostic Test Lists
  • Maternity care for up to 4 live births for every insured contributor
  • Preventive care, including immunization, health education, family planning, antenatal and post-natal care
  • Consultation with specialists with a referral
  • Hospital in-patient care in a standard ward for a 15 cumulative days per year
  • Eye examination and care, excluding the provision of spectacles and contact lenses
  • A range of prostheses (limited to artificial limbs produced in Nigeria)
  • Preventive dental care and pain relief (including consultation, dental health education, amalgam filling, and simple extraction)

Exclusions for the package include:

  • Occupational/industrial injuries
  • High technology investigations, except in life-threatening emergencies
  • Injuries resulting from natural disasters, political conflicts, epidemics and extreme sports
  • Drug abuse/addiction
  • Transplant and cosmetic surgeries

The benefits packages for the informal program of the National Health Insurance Scheme (NHIS) are determined by the stakeholders through a process of consensus building. Members determine the benefits package according to local needs.
Brazil: Unified Health System (SUS)
  • Comprehensive

Brazil’s health system offers free, universal coverage. Care under the SUS is divided into basic, specialized, and high complexity categories. Basic care is composed of health promotion and disease prevention. Care is deemed specialized if the intervention requires the use of a medical specialist. Finally, complex care is composed of interventions that require the use of advanced technology and equipment.

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Brazil’s health system offers free, universal coverage. Care under the SUS is divided into basic, specialized, and high complexity categories. Basic care is composed of health promotion and disease prevention. Care is deemed specialized if the intervention requires the use of a medical specialist. Finally, complex care is composed of interventions that require the use of advanced technology and equipment.

The PSF’s original priority areas were: women’s health, child health, hypertension, diabetes, tuberculosis, leprosy, HIV, oral health, and health promotion.

Unified Health System (SUS)

Benefits package

Types of Benefits: Comprehensive

Brazil’s health system offers free, universal coverage. Care under the SUS is divided into basic, specialized, and high complexity categories. Basic care is composed of health promotion and disease prevention. Care is deemed specialized if the intervention requires the use of a medical specialist. Finally, complex care is composed of interventions that require the use of advanced technology and equipment.

The PSF’s original priority areas were: women’s health, child health, hypertension, diabetes, tuberculosis, leprosy, HIV, oral health, and health promotion.